title: Pituitary and adrenal involvement in diffuse large B-cell lymphoma, with recovery of their function after chemotherapy.
abstract: BACKGROUND
  Diffuse large B-cell lymphoma sometimes involves the endocrine organs, but involvement of both the pituitary and adrenal glands is extremely rare. Involvement of these structures can lead to hypopituitarism and adrenal insufficiency, and subsequent recovery of their function is rarely seen. The present report describes an extremely rare case of pituitary and adrenal diffuse large B-cell lymphoma presenting with hypopituitarism and adrenal insufficiency with subsequent recovery of pituitary and adrenal function after successful treatment of the lymphoma.
  
  
  METHODS
  A 63-year-old Japanese man was referred to our hospital due to miosis, ptosis, hypohidrosis of his left face, polydipsia and polyuria. 18F-fluorodeoxy glucose positron emission tomography / computed tomography revealed hotspots in the pituitary gland, bilateral adrenal glands and the apex of his left lung. Surgical biopsy from the pituitary lesion confirmed the diagnosis of diffuse large B-cell lymphoma, with lymphoma cells replacing normal pituitary tissue. Endocrine function tests revealed adrenal insufficiency and panhypopituitarism, including a possible affection of the posterior pituitary. Hormone replacement therapy with desmopressin and hydrocortisone was started. Chemotherapy consisted of six courses of R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin and prednisolone) and two courses of high-dose methotrexate followed by autologous hematopoietic stem cell transplantation. Subsequently, his pituitary and bilateral adrenal lesions resolved, and serial endocrine function tests showed gradual improvement in pituitary and adrenal function.
  
  
  CONCLUSIONS
  The present report describes an extremely rare case of diffuse large B-cell lymphoma with involvement of both the pituitary and bilateral adrenal glands. R-CHOP and high-dose methotrexate therapy followed by autologous hematopoietic stem cell transplantation was quite effective, and panhypopituitarism and adrenal insufficiency improved to almost normal values after successful treatment of the lymphoma with chemotherapy.
authors.affiliation: Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. mshira@intmed3.med.kyushu-u.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nakashima
authors.forename: Motoaki
authors.initials: M
authors.lastname: Shiratsuchi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Abe
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Miyata
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ohno
authors.forename: Motohiko
authors.initials: M
authors.lastname: Ikeda
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Matsushima
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Nomura
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Takayanagi